Provider Demographics
NPI:1134634801
Name:PATEL, GHANSHYAMBHAI
Entity Type:Individual
Prefix:
First Name:GHANSHYAMBHAI
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WISNIEWSKI RD
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1587
Mailing Address - Country:US
Mailing Address - Phone:732-666-3264
Mailing Address - Fax:
Practice Address - Street 1:637 W EDGAR RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6574
Practice Address - Country:US
Practice Address - Phone:908-523-1663
Practice Address - Fax:908-523-0891
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03205600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist